Madam, - Maria Creggy (Oct 30th) is right when she suggests that the arrival of Vivas into the health insurance market may not be as welcome as it initially appears. She highlights the fact that private hospitals do not have Accident and Emergency (A&E) departments, and that patients treated in these hospitals require evaluation in our overcrowded public hospital emergency departments when they become acutely ill.
Ireland has a private sickness - not health - insurance system, heavily subsidised by the taxpayer, that provides more rapid access to care for the privately insured individual at the expense of his less well off fellow citizen, whose taxes nonetheless subsidise the privately insured individual and consequently the inequitable two-tier system.
Most private sickness insurance systems, including our own, are essentially fee for service. Prof Alain Enthoven of Stanford University - a strong advocate of competition in healthcare - believes that this is the costliest form of healthcare, and one that provides consumers of healthcare debatable value for money. "Competitive" health insurance markets have failed to control costs, and Prof Enthoven has advised the British NHS not to proceed with a market-based insurance system on the grounds that current "competitive" insurance systems had failed to provide cost control.
Deloitte, the authors of the value for money audit of the Irish healthcare system, have strongly cautioned against a move to an insurance system to finance our health service.
Vivas's entry into our illusory "competitive" health insurance market will not give rise to cost control or good value for money, which are the fruits of a true competitive market.
To highlight the above, Vivas have recently written to all doctors indicating that they will pay exactly the same fee to the doctor for treatments as BUPA and VHI. Now, there's competition! It's a "win win" for the providers and a "con con" by the insurers, particularly BUPA and now Vivas, who, along with AIB, will profit on the backs of a deluded consumer and Government.
What we really have is an insurance cartel, which has not proven itself to be truly competitive, consistent with the views of Prof Enthoven and the Value for Money Auditors..
Our view that competition is lacking in this market would appear to be shared by the Competition Authority, which is currently investigating this area.
Finally, while we agree in general with Maria Creggy's view of the health insurance market, we disagree with her concluding comment that implementation of the Hanly reforms will help solve our A&E problem. These reforms will result in the closure of many accident and emergency departments and acute care beds in our smaller hospitals and serve only to exacerbate the crisis in our larger hospitals.
The core solution to our problems lies in a greatly improved primary care service, fully integrated with an appropriately resourced hospital system, which would allow many of the patients currently seen in our A&E departments to be treated closer to home by their general practitioner and primary care team. This will need funding by a socially conscious government rather than a non-competitive health insurance market. - Yours, etc.,
PEADAR McMAHON, Chairperson,
Dr JOHN BARTON, Vice-chairperson,
Dr TOM NOLAN, Secretary,
Senator KATHLEEN O'MEARA, PRO,
Health Services Action Group,
Portiuncula Hospital,
Ballinasloe,
Co Galway.